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Minimising the impact of a common - but potentially detrimental - clinical practice

Intrapartum antimicrobial prophylaxis (IAP), is a standard procedure used while delivering babies. According to EU-funded researchers, it may have important implications for infant health, increasing risks of obesity, diabetes, and antibiotics resistance. This finding opens the door to the development of new dietary strategies for minimising the effect of this very common medical procedure.

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Across Western countries, the risks of non-communicable diseases, such as allergies, metabolic and neurodevelopment disorders, and obesity, are on the rise. As this increase is likely the result of dietary changes, research into treating such diseases tends to focus on the gut.

“The establishment of intestinal microbiota, or the millions of microorganisms that live in our gut, during early childhood is critical to the development of our immune system, physiology, and overall health,” says Silvia Arboleya, PhD, a Marie Skłodowska-Curie postdoctoral researcher at Spain’s Dairy Research Institute of Asturias.

According to Arboleya, it is well known that the establishment of healthy intestinal microbiota can be affected by such factors as delivery, feeding regimen, gestational age and the use of antibiotics. “What we don’t know is how other perinatal factors, such as intrapartum antimicrobial prophylaxis, or IAP, impact this process,” she adds.

To find out, IAPEMIDE, an EU-funded project led by Arboleya, is studying the impact that IAP has on the establishment of intestinal microbiota in newborns and on their development of antibiotic resistant genes.

IAP is an effective procedure long used for reducing neonatal mortality. However, it is also being used for a number of clinical situations where no clear benefit has been demonstrated. In some cases, its use has even been linked to harmful side-effects.

Understanding IAP’s immediate and long-term impact

The goal of the project was to provide an in-depth understanding of maternal IAP’s immediate and long-term impact. “We wanted to identify how maternal IAP altered the development of neonatal gut microbiota and triggered an antibiotic resistance,” remarks Arboleya. “With this information in hand, we then aimed to develop specific dietary strategies for minimising the impact of this common and potentially detrimental clinical practice.”

To do this, researchers collected faecal samples from babies at 2, 10, 30 and 90 days and then again at 6 and 12 months. After processing these samples to isolate DNA and faecal water, they were able to determine that the babies whose mothers received IAP saw alterations in the composition of their gut microbiota.
“Bacterial families such as Enterobacteriaceae, which includes a wide range of pathogens, were increased in the gut microbiome of IAP babies,” explains Arboleya. “However, other beneficial bacteria groups, such as Bifidobacterium and Bacteroides – both of which are very important at the beginning of life – were decreased in this group of babies.”

The project also studied whether diet could help correct the alterations observed on the gut microbiota of IAP babies. Here, researchers compared data derived from breast-fed and formula-fed babies in both IAP and non-IAP babies. “Although this research remains ongoing, what we are seeing suggests that feeding IAP babies breast milk helps maintain higher levels of beneficial bacteria,” says Arboleya.

Finally, to understand how IAP impacts antibiotic resistance, researchers analysed the subjects’ antibiotic resistance genes. “Interestingly, we found an increased number of infants harbouring genes linked to antibiotic resistance in the group from IAP mothers compared to those who weren’t exposed to IAP,” notes Arboleya.

Reducing non-communicable diseases

The IAPEMIDE project clearly shows that IAP not only modifies the composition of gut microbiota, but also increases antibiotic resistance. “IAPEMIDE succeeded at generating new information about the role of gut microbiota, antibiotics and probiotics in neonatal development and health,” explains Arboleya. “Moreover, it provides the basis for developing new dietary strategies for minimising the effect of one of medicine’s most common practices, ultimately reducing non-communicable diseases and antibiotic resistance later in life.”

Arboleya has presented the project’s findings at numerous international workshops and conferences. “The Marie Skłodowska-Curie Action allowed me to enhance and gain competences and reinforce myself as a mature, independent researcher,” she concludes.

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Project details

Project acronym
IAPEMIDE
Project number
749255
Project coordinator
Spain
Project participants:
Spain
Total cost
€ 158 121
EU Contribution
€ 158 121
Project duration
-

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